Predictors of Digit Replantation and Revascularization Outcomes
Location
LSUHSC-NO Center for Advanced Learning and Simulation
Document Type
Presentation
Start Date
21-6-2025 10:20 AM
End Date
21-6-2025 11:15 AM
Publication Date
June 2025
Description
Introduction: The purpose of this study was to determine how different factors affect digit replantation and revascularization outcomes. We hypothesized that positive outcomes would be associated with primary arterial/venous repairs, less comorbidities, and shorter ischemia times.
Methods: Patients that received digit replantation or revascularization procedures between 2019- 2024 were queried through our institution’s electronic medical record system using ICD-10 code. Extracted data included demographics, injury characteristics, peri-operative management, and surgical techniques. Statistical analysis was performed using Fisher’s exact tests and Mann-Whitney U tests, with p<0.05 for statistical significance.
Results: Our analysis included 19 replantation patients (21 digits) and 25 revascularizations patients (39 digits), with success rates of 37% and 80%, respectively, and an overall success rate of 61%. Time from injury to presentation for replants had a mean time of 2.7 hours for successful replants and 4.9 hours for failures (P=.04). The mean Elixhauser comorbidity index for revascularization patients was 0.4 for successes and 5.0 for failures (P<.001), with the most significant comorbidity being cardiac arrhythmia (OR 0.02, P=.004). Sharp injuries had a revascularization success rate of 95% while crush/avulsion injuries were 47% (P=.001). Replants with one artery repaired by venous autograft and at least one repaired vein had a 78% higher success rate compared to other vessel repair combinations (OR 23, P=.03). In nonsharp injuries, increased success rates were associated with primary venous repairs (OR 20, P=.03), while primary arterial repairs were negatively associated (OR 0.1, P=.049). Revascularization success was 66% higher when concomitant nerve repair was performed (OR 35, P<.001). Intraop use of papaverine during vessels anastomosis decreased revascularization success rates by 45% (OR 0.08, P=.002). Heparin drip at 500 U/h post-op to discharge increased replant patient success rate by 55% (OR 13, P=.04). Patients receiving leech therapy after a salvage procedure had a 46% lower success rate compared to those without (OR 0.14, P=0.007). However, leech therapy had a mean initiation time of 1.0 hours after surgery for success, and 4.3 hours after surgery for failures (P=.03). Surgeons with hand fellowship training had a 55% higher digit revascularization success rate compared to plastic surgeons without hand fellowship training (OR 12, P=.04).
Discussion: Success rates in digit salvage are influenced by a multitude of factors. Ischemia time, mechanism of injury, and comorbidities seem to be the strongest pre-operative indicators of digit salvage. Potential limitations include small sample sizes and data being limited to chart review. Some treatment options had better success rates with certain injury groups, suggesting injury-specific management may improve outcomes.
Significance/Clinical relevance: This study identifies patient- and treatment-specific factors that significantly impact digit salvage outcomes and supports enhanced clinical decision-making in replantation and revascularization.
Recommended Citation
Delahoussaye, William, "Predictors of Digit Replantation and Revascularization Outcomes" (2025). Dept. of Orthopaedics: Robert D. D’Ambrosia Lectureship & Research Day. 6.
https://digitalscholar.lsuhsc.edu/ortho_rd/2025/presentation2/6
Predictors of Digit Replantation and Revascularization Outcomes
LSUHSC-NO Center for Advanced Learning and Simulation
Introduction: The purpose of this study was to determine how different factors affect digit replantation and revascularization outcomes. We hypothesized that positive outcomes would be associated with primary arterial/venous repairs, less comorbidities, and shorter ischemia times.
Methods: Patients that received digit replantation or revascularization procedures between 2019- 2024 were queried through our institution’s electronic medical record system using ICD-10 code. Extracted data included demographics, injury characteristics, peri-operative management, and surgical techniques. Statistical analysis was performed using Fisher’s exact tests and Mann-Whitney U tests, with p<0.05 for statistical significance.
Results: Our analysis included 19 replantation patients (21 digits) and 25 revascularizations patients (39 digits), with success rates of 37% and 80%, respectively, and an overall success rate of 61%. Time from injury to presentation for replants had a mean time of 2.7 hours for successful replants and 4.9 hours for failures (P=.04). The mean Elixhauser comorbidity index for revascularization patients was 0.4 for successes and 5.0 for failures (P<.001), with the most significant comorbidity being cardiac arrhythmia (OR 0.02, P=.004). Sharp injuries had a revascularization success rate of 95% while crush/avulsion injuries were 47% (P=.001). Replants with one artery repaired by venous autograft and at least one repaired vein had a 78% higher success rate compared to other vessel repair combinations (OR 23, P=.03). In nonsharp injuries, increased success rates were associated with primary venous repairs (OR 20, P=.03), while primary arterial repairs were negatively associated (OR 0.1, P=.049). Revascularization success was 66% higher when concomitant nerve repair was performed (OR 35, P<.001). Intraop use of papaverine during vessels anastomosis decreased revascularization success rates by 45% (OR 0.08, P=.002). Heparin drip at 500 U/h post-op to discharge increased replant patient success rate by 55% (OR 13, P=.04). Patients receiving leech therapy after a salvage procedure had a 46% lower success rate compared to those without (OR 0.14, P=0.007). However, leech therapy had a mean initiation time of 1.0 hours after surgery for success, and 4.3 hours after surgery for failures (P=.03). Surgeons with hand fellowship training had a 55% higher digit revascularization success rate compared to plastic surgeons without hand fellowship training (OR 12, P=.04).
Discussion: Success rates in digit salvage are influenced by a multitude of factors. Ischemia time, mechanism of injury, and comorbidities seem to be the strongest pre-operative indicators of digit salvage. Potential limitations include small sample sizes and data being limited to chart review. Some treatment options had better success rates with certain injury groups, suggesting injury-specific management may improve outcomes.
Significance/Clinical relevance: This study identifies patient- and treatment-specific factors that significantly impact digit salvage outcomes and supports enhanced clinical decision-making in replantation and revascularization.
Comments
Student and Fellow Presentation